The Medicare program has offered dialysis providers financial incentives to place more patients on peritoneal dialysis. But nephrologists need to know more about the modality option to make for a smooth transition. At the American Society of Nephrology Kidney Week session, “Moving the field forward in PD” on Nov. 7, speakers offered ideas on how to expand the reach of the modality and improve technique survival. Peritoneal dialysis, as a modality choice, may have its own natural limits, speakers noted. Waning residual renal function and peritonitis can be two elements that challenge the longevity of the therapy. Looking for markers, such as low albumin, should be considered so that a transition to another modality is not based on “burnout” but on a choice to look for improved adequacy.
Reducing the risks of peritonitis has made tremendous progress; some countries have reduced the rate by more than half, the speakers noted. Improvements in connectology and better training of patients (education, home visits, etc.) on how to avoid infection has helped to reduce the risks. Placing a patient on PD also helps reduce the risks that central venous catheters provide for patients who end up on hemodialysis. The "nature of the access" can provide a survival benefit for PD among patients over in-center hemodialysis, particularly in the first two years of therapy.
The key to a successful life on PD, noted nephrologist and session speaker Isaac Teitelbaum, is not always about being “obsessed” with comparing survival with other modalities. “It’s about delivering a good quality of life for patients,” and PD has the opportunity to do that, he said.